EHR-S Roll Out Planning & Strategies

A Rollout Strategy should be chosen by the agency in collaboration with their project manager and vendor. It should be based on the agency’s priorities, organizational structure, current issues/projects underway, schedules, continuity of service delivery, revenue assurance, locations, training capacity, risks, and the product driven workflows.

There are several possible methods to choose from for an EHR-S roll-out and no one method is right or wrong. We will discuss several here. Depending on the agency and the product, some methods may be more appropriate than others.

1. Billing First
2. Clinical First
3. Rolling Clinical + Billing
4. Big Bang

All rollout methodologies should include a Pilot, which is essentially the final test phase. A Pilot should be done ‘in production’, meaning that it is a ‘live’ test of the system and the agency procedures and staff, as well as a test of the training. A Pilot should be conducted with one set of users that can go live with minimal disruption, using standard training and workflows.

Note: Keep in mind that LACDMH requires billing transitions to EDI be done by reporting unit.

DECISIONS:
First you need to make a few short term decisions.

• Will you transition to LACDMH EDI billing prior to their implementation of their new IBHIS system? Several agencies are doing this now. See the list here, http://dmh.lacounty.info/hipaa/EDI_Status.htm . This will require you and your vendor to develop the custom EDI claims transactions that LACDMH supportd today, then you and your vendor will need to modify the claims transactions to meet the new specifications LACDMH will release once the IBHIS product/vendor has been selected. Be sure to determine whether your vendor will charge additional fees for the IBHIS transition if you go live with EDI pre-IBHIS first?
• Will you need to redeploy any staff into new roles or downsize? If you decide you want to avoid a two step billing EDI transition, then you must continue to support the double data entry until IBHIS, entering claims/service data first into your new EHR-S and then also into the LACDMH IS.

Now you need to do some pre-planning in order to select the best methodology for your situation. For example, develop your roll-out objectives and a list of issues to avoid. What are your top priorities for implementing an EHR-S? Focus on these with your roll-out to assure they are accomplished. E.g. issues with claims denials, compliance during audits, managing productivity, etc.? They will drive your decision to roll-out billing or clinical solutions first.

Once you have purchased your EHR-S, you can begin the implementation planning process with your project manager and vendor. You do not need to select a roll-out methodology right away, but don't put it off too long. You will want a chance o get to know the product to make the best decision.

METHODOLOGIES:

1/ Billing first >> then clinical one program/payor/site at a time.

A good strategy for agencies that plan to implement EDI claims processing immediately, even pre-IBHIS. Works well when billing/data entry is centralized under one management team and the procedures are uniform already.

May not be a desirable strategy if EDI will be delayed. Data entry staff can be used to enter all data required to issue a claim. If EDI is immediately implemented, you can avoid increasing the staff/time here initially to handle the double data entry.

Consider organizing data entry into same teams as clinical roll-out, to synch the clinical roll-on with the roll-off of data entry staff. Then once all billing is live and working well, clinical staff roll-out can begin in phases while phases out the data entry staff.

You may also consider the clinical roll-out in functional phases, going back to each program multiple times to phase in each set of functionality. E.g. train clinical staff initially to enter all billing related data, keep all other data on paper initially. This allows data entry staff roll-off and first phase using learned/proven tasks.

You must determine if double data entry into the LACDMH IS is necessary or will you go straight to EDI in this phase. Additional staff hours will be required if you require double data entry initially.

Process Outline:
1. Form data entry teams
2. Train data entry teams to enter only billing required data and process claims
3. Provide clinical staff with forms to enable data entry
4. Run a small/short Data entry Pilot, including EDI
5. Go online with all billing data, including EDI claims
6. Train first clinical team
7. Go online with first phase of clinical data entry
8. Redeploy first data entry team
9. Repeat 7 & 8 until all clinical teams are online

Pros:

• Data entry staff and leads are computer literate, require less training, do not impact service delivery.
• Billings will be online first in the rollout schedule, i.e. full production of billing can happen more quickly than the clinical roll-out.
• Data entry team may be a good source for the Pilot to prove the processes and system set-up prior to rolling out to the clinical teams.
• Immediate streamlining of billing and financial reporting, with some clinical records available for reporting.
• Roll-off of billing/data entry staff can be done in concert with the clinical roll-outs
• Data entry staff learn system and can be redeployed within the organization, e.g. help desk, training.
• Training timeline will be short, only a few roles can be assigned
  
  Cons:
• Delays clinical electronic chart implementation and all the benefits of tying service recordings to notes etc.
• Training of staff who may ultimately be redeployed for other non-EHR-S roles
• Current issues with Progress Notes and compliance, etc. will continue

2/ Clinical first >> one at a time, then all billing

Process Outline:
1. Determine/form clinical roll-out teams
2. Train first clinical roll-out team (pilot) to enter first phase of data
3. Train billing/data entry staff to use new reports for LACDMH IS data entry
4. Run a small clinical pilot
5. Go online with first phase of clinical data entry
6. Provide daily data entry reports for billing/data entry staff to enter into LACDMH IS
7. Repeat 2,3,5, & 6 until all clinical teams are online
8. Train billing team to process claims
9. Run a small billing/EDI pilot
10. Go online with all billing data, including EDI claims
11. Redeploy unnecessary data entry/billing staff

Pros:

• Enables documentation at point of service
• Assures audit risks are known, e.g. will know if PN has been entered before billing in IS
• Biggest challenge first
  
  Cons:
• Risk losing billing/data entry staff before you go live with billing
• Double data entry until billing goes online
  

3/ Rolling Clinical + Billing >> one at a time, must be RU groupings.

• Financial reporting will cross 2 systems, so manual or other automated methods for reconcilliation and data combining will be required until the entire roll-out is complete.

4/ Big Bang >> everyone and everything at once.

• Viable for small agencies with one site, and minimal programs and users.